Robotic Knee Replacement Surgery

 

Table of Content:

• • Benefits of Robotic Knee Replacement compared to Conventional Knee Replacement
  • What is Robotic Knee Replacement Surgery
  • Types of Robotic Knee Replacement
  • What are the Key Features of Robotic Knee Replacement?
  • Surgical Procedure
  • The Role of the Robotic Arm
  • Recovery Process After Robotic Knee Replacement
  • Who is a Candidate for Robotic Knee Replacement?

Benefits of Robotic Knee Replacement compared to Conventional Knee Replacement:

• 3-Dimensional Pre-operative Planning 
• Personalized Surgical Plan
• Precise intraoperative execution of Implant Replacement
• Real- time Dynamic Soft tissue balancing
• Safe and Efficient
• Faster Recovery/Better Outcomes

What is Robotic Knee Replacement Surgery

Robotic knee replacement uses sophisticated technology to perform knee replacement surgery. This innovative approach involves the removal of damaged knee tissue and its replacement with an artificial joint, using a robotic arm. Unlike traditional knee replacement surgeries, where the surgeon relies solely on their skill and experience using manual jigs and cutting tools, robotic knee replacement utilizes advanced technology to guide the surgeon throughout the procedure, reducing the risk of human error.

This has dramatically enhanced surgical accuracy, precision and outcomes of knee replacement surgeries. This article covers how the procedure works, its advantages, and what to expect from the surgery. Learn about the benefits of robotic-assisted knee replacement and why it may be a better option for you.

 

Are you looking for the Specialist of the Robotic Knee Replacement? You are at the right Specialist Clinic. Dr Kelvin Tan provides dedicated treatment plan to ensure your smooth recovery and committed to understand your conditions and needs.

• The region’s first few Mako Robotic trainer in Partial Knee, Total Knee and Total Hip replacement and has performed more than 500 Robotic Joint Replacements.
• Key opinion leader locally and internationally in the field of Robotics and Enhanced Recovery After Surgery (ERAS) for Knee Replacement
• Highly Experienced & Skillful in Joint Reconstruction
• Specialist in Robotic & Computer Navigated Surgery

 

Types of Robotic Knee Replacement

Partial Knee Replacement or Unicompartmental Knee arthroplasty (UKR)

About 20% of Osteoarthritis (OA) knees are confined to a single compartment (usually medial). A medial Unicompartmental Knee arthroplasty (UKR) can be performed for this group of patients instead of TKR which is commonly performed instead. The advantages of performing a UKR over a TKR includes a smaller incision, lesser pain, blood loss and bone resection, faster return to work and more normal knee kinematic due to preservation of native ligaments. UKR may not be suitable for all patients so it’s best to check with your surgeon if you are a suitable candidate.

Using conventional instruments to perform UKR is susceptible to considerable alignment, rotational, sizing errors as well as periprosthetic fractures resulting in suboptimal survivorship compared to TKR. Robotic UKR has proven to be a game-changer so far, resulting in consistently accurate alignment, reproducible results, optimal implant sizing and placement, soft tissue balancing, better forgotten joint scores (a score that measures patients’ awareness of their joint after a joint replacement) and lower revision rate.

Total Knee Replacement (TKR)

TKR is typically done for patients suffering from end stage tricompartmental osteoarthritis. In contrast to a UKR, the entire tibia-femoral compartment is replaced, often sacrificing 1 to 2 of the cruciate ligaments. Both UKR and TKR have excellent long-term results with TKR having slightly higher survivorship compared to UKR and is the more commonly performed operation. Using Robotic to perform TKR has enabled TKR outcomes to be better and more reproducible.

What are the Key Features of Robotic Knee Replacement?

1.Preoperative Planning and Personalized Surgical Plan

Before the procedure, advanced imaging, such as CT scans, is employed to generate a highly detailed 3-Dimensional model of the patient’s joint anatomy. This is far superior to the traditional 2-Dimensional templating which was susceptible to inaccuracies. The comprehensive virtual representation enables surgeons to customize surgical plans according to the patient’s unique joint structure, biomechanics, and individual health factors.

2.Real-time Feedback, Dynamic soft tissue balancing and precise intraoperative execution

During surgery, the robotic system serves as a virtual assistant to the surgeon, providing real-time feedback, dynamic joint balancing and ensuring the precise execution of the surgical plan. The key advantage of robotics in joint replacement surgery lies in its ability to deliver unparalleled precision by executing movements with submillimeter accuracy, far surpassing the capabilities of human hands alone. This level of precision leads to better implant alignment, reduced soft tissue damage¹ and improved joint mechanics. The minimally invasive nature of robotic-assisted joint replacements leads to smaller incisions, less postoperative pain, and quicker recovery for patients.

3.Safety and Efficiency

Some robotic systems employ state of the art haptic boundaries that prevent cutting tools from veering into vital neurovascular structures and therefore provide a safety check in modern robotic instrumentation. Also, with sophisticated 3-Dimensional planning, implant sizes are known beforehand, and this results in improved Operating Room efficiency. The precise guidance provided by robotic arms reduces the need for repeated corrections, thereby streamlining surgical workflows, shortening workflows, shortening surgery duration and optimizing operating room utilization.

4.Enhanced Outcomes and Patient Satisfaction

Numerous studies² have demonstrated the superiority of robotic-assisted joint replacements compared to traditional techniques. Patients who undergo robotic-assisted procedures experience reduced postoperative pain, shorter hospital stays, and faster return to daily activities³. Additionally, improved alignment and stability of the implanted joint contribute to enhanced long-term outcomes and increased patient satisfaction⁴.

Through computer-aided planning, the optimal implant size and positioning are precisely determined to achieve optimal alignment and stability¹. This personalized approach to joint replacements enhances the fit of the prosthesis, reduces the risk of complications, and extends the lifespan of the implant, leading to improved patient outcomes and longevity of the implant.

Surgical Procedure

Before: The surgical procedure for robotic knee replacement involves several key steps, from preoperative planning to postoperative care. Advanced imaging or intraoperative anatomical modeling are used to create a three-dimensional model of the knee, evaluating each patient’s bone structure and joint alignment. Based on this data, surgeons generate a personalized pre-operative plan tailored to the patient’s anatomy.

During the surgery, tracking pins are placed to help the robotic system locate the knee in real-time, like a GPS system. The robotic surgery system is used to assist the surgeon in making precise bone cuts, guided by the surgeon using a handheld tool. This ensures that only the exact amount of bone required is removed, according to the pre-operative plan, to sub-millimeter accuracy. The robotic system also provides real-time dynamic soft tissue balancing. This meticulous process helps to achieve far superior outcomes and reduce the likelihood of complications.

The Role of the Robotic Arm

The robotic arm plays a crucial role in robotic knee replacement surgery, ensuring accurate bone removal and implant placement according to the pre-established surgical plan. During the procedure, the robotic arm assists the surgeon by providing real-time feedback, ensuring that the bone cuts are precise, safety boundaries are not breached, and the implant is positioned accurately. There are various robotic systems in the market with Mako Robot (Stryker) being the predominant robot used so far.

Recovery Process After Robotic Knee Replacement

The recovery process after robotic knee replacement surgery is typically smoother and faster compared to traditional methods. Patients often resume daily activities within a few weeks to several months post-surgery, depending on their individual fitness, motivation, and the severity of knee damage. The use of robotic technology is hugely complementary with Enhanced Recovery after Surgery Protocols, allowing for faster recovery times and quicker return to normal activities.

Initial Recovery Phase

The initial recovery phase after total knee replacement surgery involves several key steps. Pain management is essential to allow early functional recovery, and with our comprehensive ERAS protocols, many of our patients report being able to cope with the postoperative knee pain and ability to perform activities of daily living soon after the procedure. Patients may require mobility aids such as crutches or a walker to assist with movement shortly after surgery. 

Physical Therapy and Rehabilitation

Physical therapy and rehabilitation play a vital role in the recovery process after robotic knee replacement surgery. This is essential for regaining knee strength, flexibility, and mobility. Patients are encouraged to engage in low-impact activities that support rehabilitation, such as walking and swimming.

Long-term Recovery and Maintenance

Long-term recovery and maintenance are crucial for the lasting success of knee replacement surgery. With appropriate activity modification and adherence to follow-up care instructions, knee replacements can last for many years. Gradually, patients can expect to resume normal activities within 4 to 6 weeks post-surgery, depending on their individual recovery progress. However, higher demand activities can take up to 3 to 6 months.

Who is a Candidate for Robotic Knee Replacement?

Typically, candidates for traditional knee replacement are also suitable for robotic-assisted knee replacement. This includes anyone who is suffering from severe knee pain, limited mobility, severe deformity, and degenerative knee osteoarthritis, inflammatory or rheumatoid arthritis or post traumatic arthritis and have failed other forms of non-surgical treatment.

Contraindications

Several contraindications can disqualify a patient from undergoing robotic knee replacement surgery. These include:

• Active infections
• Poor cardiac or general health
• Severe vascular disease
• Muscular or neurological conditions 

 

Appointment

 

 

 

 

References

1. Pietrzak JRT, Rowan FE, Kayani B, Donaldson MJ, Huq SS, Haddad FS. Preoperative CT-Based Three-Dimensional Templating in Robot-Assisted Total Knee ReplacementTotal Knee Arthroplasty More Accurately Predicts Implant Sizes than Two-Dimensional Templating. J Knee Surgery. 2018 Aug 1.
2. Haddad, F. S., & Sukeik, M. (2018). Robot-assisted orthopaedic surgery: A systematic review. Bone & Joint Research, 7(6), 511-513.
3. Kayani B, Konan S, Pietrzak JRT, Haddad FS. Iatrogenic Bone and Soft Tissue Trauma in Robotic-Arm Assisted Total Knee ReplacementTotal Knee Arthroplasty Compared with Conventional Jig-Based Total Knee ReplacementTotal Knee Arthroplasty: A Prospective Cohort Study and Validation of a New Classification System. The Journal of Arthroplasty 33 (2018) 2496-2501.
4. Kayani B, Konan S, J Tahmassebi, Pietrzak JRT, Haddad FS. Robotic-arm assisted Total Knee  arthroplasty is associated with improved early functional recovery and reduced time to hospital discharge compared with conventional jig-based Total Knee arthroplasty. A prospective cohort study. Bone Joint J 2018;100-B:930–7.
5. Jerabek SA, Matt Thompson, Carroll KM, Mayman DJ, Padgett DE. Accuracy of Cup Positioning, COR Restoration and Achieving Desired Hip Length and Offset with Robotic Total Hip Arthroplasty.

BIO OF DR KELVIN TAN GUOPING

Dr Kelvin Tan Guoping is a strong advocate of technology-enabling joint replacements such as computer navigation and robotic-assisted surgeries that can improve patient outcomes and simplify complex surgeries. He is recognized locally and internationally as a key opinion leader in Robotics and ERAS (Enhanced Recovery after Surgery). He is the region’s first few Mako Robotic trainer in Partial Knee, Total Knee and Total Hip replacement and has performed more than 500 Robotic Joint Replacements.

Dr. Kelvin Tan was the previous Head of the Adult Reconstruction Joint Replacement unit in Tan Tock Seng Hospital, Singapore spearheading the Enhanced Recovery After Surgery (ERAS) Knee Replacement Taskforce, dramatically reducing the average length of hospital stay, transforming knee replacement into ambulatory surgery care and significantly improved patient outcomes and experiences post-surgery.  He is currently the President of the Singapore Arthroplasty Society, Young Surgeon Nominate for Singapore and an Adjunct Assistant Professor at National University of Singapore (NUS)

Are you looking for the Expert of the Robotic Knee Replacement? You are at the right Specialist Clinic. Dr Kelvin Tan provides dedicated treatment plan to ensure your smooth recovery and committed to understand your conditions and needs.

• Expert in Robotic & Computer Navigated Surgery
• Highly Experienced & Skillful in Joint Reconstruction
• Key opinion leader locally and internationally in the field of Robotics and Enhanced Recovery After Surgery (ERAS) for Knee Replacement

 

Robotic Joint Replacement with MAKOPLASTY SYSTEM

Hundreds of thousands of joint replacements are performed worldwide every year to replace worn cartilage in knee and hips. Each implant is designed to replicate joint movement in a certain way and need to be inserted in a certain alignment and rotation to make them function most efficiently. 

Robotic surgery aims to remove surgical errors by providing a higher degree of accuracy and reproducibility of results. Dr Kelvin Tan is Key Opinion leader in Robotic Joint Replacements as well as Enhanced Recovery After Surgery (ERAS) for Knee Replacement.

Although excellent results can be achieved using conventional joint replacement techniques, Dr Kelvin Tan believes that robotic surgery can give increased accuracy, better preoperative planning, and reliable, reproducible results particularly in technically challenging and revision cases.